1 / 33

CNS infection

Meninges . Terminology and definition. Meningitis EncephalitisMyelitisMeningoencephalitisMeningomyelitisEncephalomyelitisMeningo-encephalomyelitisBrain abscess. Meningitis . Meningitis . Purulent meningitis - polymorphonuclear cell - WBC > 1000 celss/mm3 - pyogenic bacteriaLymphocytic meningitisEosinophillic meningitis - eosinophil > 5% - parasiteCarcinomatous meningitis.

Sophia
Télécharger la présentation

CNS infection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. CNS infection Kulthida Methawasin Neurology unit, Department of Medicine Srinakharinwirot University

    2. Meninges

    4. Terminology and definition Meningitis Encephalitis Myelitis Meningoencephalitis Meningomyelitis Encephalomyelitis Meningo-encephalomyelitis Brain abscess

    5. Meningitis

    6. Meningitis Purulent meningitis - polymorphonuclear cell - WBC > 1000 celss/mm3 - pyogenic bacteria Lymphocytic meningitis Eosinophillic meningitis - eosinophil > 5% - parasite Carcinomatous meningitis

    7. Pathogenic organism Virus Bacteria Mycobacterium Fungus – Cryptococcus neoformans Parasite – Angiostrongylus cantonensis, Gnathostomiasis, Cysticercosis Nocardia Actinomycosis Protozoa Rickettsia Spirochete Mycoplasma

    8. Pathogenesis Hematogenous spreading Parameningeal structures – sinusitis, mastoiditis, otitis media, dental carries Direct infection to the subarachnoid space – fracture base of skull, dermal sinus tract, ruptured meningoceal Direct infection – surgery, lumbar puncture Cranial nerve and peripheral nerve – rabies encephalitis, herpes simplex encephalitis

    9. Symptoms and signs Fever Headache Nausea and vomitting Period - acute period: within 1 week bacteria, virus, amoeba, parasite, systemic infection - subacute period: 1- 4 weeks tuberculosis, fungus, parasite, spirochete, systemic infection - chronic period: > 4 weeks

    10. Chronic meningitis Infectious causes Noninfectious causes M.Tuberculosis Neoplasm Cryptococus neoformans Vasculitis Cysticercosis SLE Angiostrongylus cantonensis Vogt-Koyanagi- Harada syndrome Fungus Behcet’s disease Treponema pallidum Chronic benign lymphocytic meningitis Nocardia asteroides Mollaret’s meningitis Actinomycosis Sjogren’s syndrome Acanthamoeba

    11. Symptoms

    12. Symptoms (children)

    13. Kernig’s sign

    14. Brudzinski’s sign

    15. Symptoms Alteration of consciousness Seizure Localizing signs: hemiparesis, paraplegia Cranial nerve palsy Autonomic hyperactivity

    16. Lumbar puncture

    17. Lumbar puncture

    18. CSF analysis The characteristics of normal CSF - open pressure: 50-200 mmCSF - clear color - cells: RBC WBC- lymphocyte < 5 cells pleocytosis - protein 20-45 mg/dl - CSF sugar/ Serum sugar > 50% - fresh smear, Gram stain, India ink, AFB, modified AFB - culture

    19. CSF analysis for differential diagnosis (acute onset)

    20. CSF analysis for differential diagnosis (acute onset)

    21. CSF analysis for differential diagnosis (subacute onset)

    22. Viral Encephalitis

    23. HSV encephalitis In adult most caused by HSV-1 Primary infection in oropharyngeal or intranasal mucosa Latent ganglionic infection Reactivation leads to encephalitis Headache, fever, alteration of conciousness LP: CSF xanthocromic stain Imaging findings: -- medial & inferior temporal lobe extending to insula lobe , orbitofrontal & limbic system

    25. VZV encephalitis After varicella develop, VZV remain within the ganglia Reactivation, spread to spinal cord & brain Encephalitis due to vasculopathy ?????????????????? Immunity ??? host -- immunocompetent host: granulomatous arteritis ( large VSS) -- immunocompromised host: small VSS imaging findings: -- multifocal areas of infarction at gray white matter -- narrowing/ occlusion of large VSS

    27. Japanese encephalitis Flavivirus, Culex- borne, Southeast Asia /China Symptoms: headache and alteration of consciousness Clinical signs (post encephalitis): tremor, dystonia, rigidity, mask-like face Mortality rate 30% Imaging findings: -- bilateral thalamus, basal ganglia, brainstem, hippocampus -- hemorrhagic transformation -- mixed gray< white involvement

    29. Rabies encephalitis Rhabdovirus family, transmission through dog bites Retrograde axonoplasmic: from CNS to peripheral, intraaxonal transport Encephalitic form involve cerebrum, brainstem, limbic system Late state involve basal ganglia and thalamus ? coma Paralytic form involve medulla, spinal cord imaging findings -- involve bilateral basal ganglia, pulvinar -- comatose stage: enhancement of areas in brain, brainstem,spinal cord & spinal nerve root

    31. Nipah viral encephalitis Outbreak occurred in Malaysia in 1998-9 among pig farmers Paramyxovirus, Culex mosquitoes - borne Clinical syndrome of encephalitis imaging finding -- white matter distribution of multiple small lesions < 1 cm in size -- cortex, brainstem, corpus callosum, thalamus DDx from ADEM and vasculopathic pathogenesis

    33. CMV encephalitis Opportunistic infection in organ transplant, HIV Ventriculoencephalitis, brainstem encephalitis, cranial nerve palsy, associated retinitis ? visual pathway imaging findings: -- enlarged ventricle -- increased periventricular signal enhancement

More Related